OR goes AI

A single operating room can cost upwards of several million dollars to equip and maintain.  Every minute that space sits empty, health systems are losing an opportunity to recoup on that investment and further enhance their revenue with billable patient services. Artificial intelligence (AI) can help—an AI-optimized operating room schedule can lead to better schedule efficiency, revenues and patient experience.

Unfortunately, operating rooms often stand idle due to scheduling issues. Most hospitals divide up their operating room time into defined blocks, a certain number of which are given out to each surgeon every week.

When one surgeon doesn’t use all of her allotted blocks, she may have the option to release that time to other providers. But when that doesn’t happen, the time simply goes unused.

“Operating room time is a precious resource for health systems, and we cannot afford to let it go to waste,” said Brian Dawson, systems vice president of perioperative services at CommonSpirit Health, the second-largest non-profit hospital chain in the United States.  “We need to offer flexible and convenient options for our patients, otherwise they’re going to seek care elsewhere.”

“As we start to see an increase in elective surgeries again after the huge hit during COVID-19, we have to make sure we’re optimizing our scheduling to provide better experiences for patients and for our surgical staff while generating revenue for the health system as a whole.”

AI offers visibility into the problem

At CommonSpirit, which serves communities in Arizona, California and Nevada, surgeons were typically scheduling elective cases between three weeks and a month in advance, Dawson explained.

Any time that was still left unused within a week or so of the surgery date was unlikely to be filled, but the owners of those blocks weren’t consistently releasing that time to colleagues. As a result, rooms stayed empty and patients experienced avoidable delays in their care.

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“To solve this problem, we partnered with LeanTaas to start using artificial intelligence to optimize our operating room scheduling,” said Dawson. “It runs through all of the surgical scheduling blocks available and finds unused time so we can reassign it to other surgeons who need it.”

“Now, surgeons get reminders at 14 days out if they haven’t scheduled any cases in their blocks yet,” he continued. “They get a total of three prompts before the block is automatically released at a certain point. If another surgeon is looking for time outside of their allotted blocks, we have a pool of available time slots they can choose from at any of our hospitals where they are credentialed to practice.”

Minutes add up into major results

The problem of unused operating room time is pervasive, but it’s not well defined in many health systems, Dawson said.

“When we started to dive into this project, we found some surprising issues,” he said. “For example, we had six robotic surgeons who owned a total of eight blocks specifically for robotic surgery. The blocks were filled about 80 percent of the time, which seemed pretty good. Yet we knew we weren’t actually doing that many robotic surgeries.”

“It turns out that 40 percent of the cases in the robotic surgery blocks were actually non-robotic surgeries. We were using rooms equipped with very expensive, specialized equipment for procedures that might not require those tools.”

The robotic surgery team acknowledged that they weren’t using up the majority of their allotted blocks for robotic procedures and agreed to relinquish some of those hours for an experiment.

“We proposed transitioning a quarter of the surgeon-specific blocks into ‘first come, first served’ blocks so that we could have more options for filling the time without reducing the total amount of hours available to the robotic surgery team,” Dawson said.

Two months later, the surgeons were very happy with the new system and didn’t feel as if they were losing out on any opportunities to care for their patients. But they still weren’t using up all of the blocks consistently.

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“Instead of having the rooms sit empty, we went in a different direction,” he explained.  We proactively recruited two new surgeons from competing health systems to add to the team to increase our surgical volume.”

“Now, the time is getting filled more frequently, our surgeons are still happy with what they have, and we’ve actively expanded our offerings for patients while increasing our revenue potential by tens of millions of dollars in the subset of hospitals where we’re using this strategy.”

Improving patient satisfaction and health system revenue

By focusing on operating room time optimization, CommonSpirit has opened up 2.6 million minutes of service that might have otherwise gone to waste, said Dawson.

“We are all operating on razor thin margins these days,” he said. “COVID-19 taught us how devastating it can be when patient volumes drop precipitously. Now we’re coping with the aftermath while facing challenges with staffing, inflation, and changing expectations from patients.”

“Everyone needs to be focused on implementing strategies to insulate against a similar situation in the future. It’s time for leaders to get creative about finding opportunities for improvement wherever they can, and those initiatives should ideally hit more than one strategic objective.”

Improving efficiency in the operating room is a promising way to achieve multiple goals simultaneously. Not only does it maximize existing resources to increase revenue, but it also keeps patients and staff more satisfied.

“Staff members feel less frustrated with trying to manage their own schedules,” noted Dawson.  “Meanwhile, patients can have their surgery done by the surgeon they choose instead of being forced to go to a competitor so they can get care in a timely manner.”

“They can get their dates locked down sooner, so they have more time to arrange childcare or work schedules during recovery. Being able to get care on their own terms is so important these days, especially in geographic areas where there are three or four different health systems to choose from.”

“It’s better for our bottom line, better for our staff, and better for our patients to maximize operating room resources in every way possible.”